OBJECTIVE: To examine the efficacy of adjunctive right prefrontal high-frequency repetitive transcranial magnetic stimulation (rTMS) treatment in adolescent mania patients as compared to sham stimulation. METHODS: Twenty six right handed patients aged 12-17 years diagnosed with bipolar mania were randomized to receive daily sessions of active or sham rTMS (20 Hz, 110% of motor threshold, 20 trains, 10 s intertrain interval) over the right dorsolateral prefrontal cortex for 10 days. Mania was rated using Young Mania Rating Scale (YMRS) and Clinical Global Impression (CGI) at baseline, and after 5th and 10th rTMS. RESULTS: For YMRS scores, repeated measures analysis of variance (ANOVA) showed a significant main effect (F=44.49, degree of freedom [df]=1.2/29.29, p<0.001, Greenhouse-Geisser corrected, effect size eta 2=0.65), but the interaction effect was not significant (F=0.03, df=1.2/29.29, p=0.912, Greenhouse-Geisser corrected). For CGI-Severity, repeated measures ANOVA showed a significant main effect (F=24.49, df=1.42/34.21, p<0.001, Greenhouse-Geisser corrected, effect size eta2=0.51), but the interaction effect was not significant (F=0.06, df=1.2/29.29, p=0.881, Greenhouse-Geisser corrected). CONCLUSION: High-frequency right prefrontal rTMS was found to be ineffective as add-on to standard pharmacotherapy in adolescent mania.
Adolescent* ; Bipolar Disorder* ; Drug Therapy ; Freedom ; Hand ; Humans ; Prefrontal Cortex* ; Transcranial Magnetic Stimulation*

Ofloxacin is a commonly used quinolone antibiotic both in adults as well as children. It is generally safe and well tolerated. Rarely, neurological and psychiatric adverse reactions are reported to occur with ofloxacin. We report a case of a child who developed delirium after ofloxacin treatment, that resolved after medication discontinuation and treatment with low dose olanzapine.
Adult ; Child* ; Delirium ; Hallucinations* ; Humans ; Ofloxacin ; Psychotic Disorders

Lithium is the first line treatment for maintenance treatment of bipolar disorder. Among the long term adverse effects, weight gain is likely to affect a subset of patients. There is no specific guideline for the treatment of lithium-induced weight gain. We report a young male with bipolar disorder who had significant weight gain with lithium (25 kg), which responded to metformin treatment at 500 mg twice daily. The proposed mechanism of weight lowering effect of metformin includes changes in hypo-thalamic physiology, including leptin and insulin sensitivity, as well as circadian rhythm changes affecting food intake, regulation of fat oxidation and storage in liver, skeletal muscle, and adipose tissue.
Adipose Tissue ; Bipolar Disorder ; Circadian Rhythm ; Eating ; Humans ; Insulin Resistance ; Leptin ; Lithium ; Liver ; Male ; Metformin* ; Muscle, Skeletal ; Physiology ; Weight Gain*

No abstract available.
Baclofen

Olanzapine is an atypical antipsychotic which is efficacious in the treatment of schizophrenia. The adverse effect profile for olanzapine is benign except for higher rates of metabolic events. Orthostatic hypotension is less commonly reported with olanzapine as compared to first-generation and few atypical antipsychotics. We report a case where olanzapine, in a dose dependent fashion, caused transient postural hypotension.
Antipsychotic Agents ; Hypotension, Orthostatic* ; Schizophrenia

The objective of our study was to examine the electroencephalogram (EEG) abnormalities associated with clozapine treatment. It was a cross-sectional study on 87 psychiatric patients on clozapine treatment. 32 channel digital EEG was recorded and analysed visually for abnormalities. EEG abnormalities were observed in 63.2% of patients. Both slowing and epileptiform activities were noted in 41.4% of patients. The EEG abnormalities were not associated with dose or duration of clozapine exposure.
Clozapine ; Cross-Sectional Studies ; Electroencephalography ; Humans ; Seizures